Grayev A M, Boal D K, Wallach D M, Segal L S
The Milton S. Hershey Medical Center, Penn State University College of Medicine, Department of Radiology, Hershey 17033, USA.
Pediatr Radiol. 2001 Aug;31(8):559-63. doi: 10.1007/s002470100497.
Metaphyseal injuries resembling the classic metaphyseal lesion (CML) of abuse may occur as the result of serial casting during treatment of clubfoot deformity. Mentioned in the orthopedic literature in 1972, this iatrogenic fracture has not been described in the radiologic literature nor has the similarity to injuries occurring with abuse been previously recognized.
To describe the mechanism and radiographic appearance of metaphyseal injury observed during serial casting of clubfoot. Note similarities to the CML of abuse.
Eight children ranging in age from 1 to 4 months underwent casting for clubfoot. Five orthopedic surgeons from three different institutions performed the casting. Two patients had spina bifida and one, arthrogryposis. A complete skeletal survey was performed on one child who was abused; there was no suspicion of abuse in the remaining seven.
All children manifest injury with periosteal new bone. One child had clear evidence of abuse with 24 rib fractures. X-rays of lower extremities in short leg casts revealed bilateral tibial metaphyseal fractures. Four other children had metaphyseal fractures resembling the CML of abuse, and three developed an area of sclerosis within the metaphysis.
In the setting of serial casting for equinovarus deformity, metaphyseal injury even the CML of abuse may be noted. Since inflicted injuries are almost always unobserved and explanations rarely offered, the fact that the CML occurs as a result of orthopedic maniuplation may offer some further insight concerning the pathogenesis of this well-described abuse injury.
在治疗马蹄内翻足畸形过程中，连续石膏固定可能导致类似虐待所致经典干骺端病变（CML）的干骺端损伤。这种医源性骨折于1972年在骨科文献中被提及，但放射学文献中尚未描述，此前也未认识到其与虐待所致损伤的相似性。
描述马蹄内翻足连续石膏固定期间观察到的干骺端损伤的机制和影像学表现。注意与虐待所致CML的相似之处。
8名年龄在1至4个月的儿童接受马蹄内翻足石膏固定。来自三个不同机构的五名骨科医生进行了石膏固定操作。两名患者患有脊柱裂，一名患有先天性多发性关节挛缩症。对一名受虐待儿童进行了完整的骨骼检查；其余七名儿童不存在虐待嫌疑。
所有儿童均表现出骨膜新生骨损伤。一名儿童有明确的虐待证据，伴有24处肋骨骨折。短腿石膏固定的下肢X线片显示双侧胫骨干骺端骨折。另外四名儿童有类似虐待所致CML的干骺端骨折，三名儿童干骺端出现硬化区。
在马蹄内翻足畸形连续石膏固定的情况下，可能会出现干骺端损伤，甚至是类似虐待所致的CML。由于虐待造成的损伤几乎总是未被观察到且很少给出解释，CML是由骨科操作导致的这一事实可能会为这种已被充分描述的虐待损伤的发病机制提供一些进一步的见解。
